Provider Demographics
NPI:1417197062
Name:CHEUNG, DIANNE SOUKFUN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:SOUKFUN
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-542-6333
Mailing Address - Fax:
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:SUITE 340
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-542-6333
Practice Address - Fax:310-542-4695
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93092207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417197062Medicaid
CADP151YMedicare PIN